title: Severe traumatic brain injury in a high-income country: an epidemiological study.
abstract: This adult cohort determined the incidence and patients' short-term outcomes of severe traumatic brain injury (sTBI) in Switzerland and age-related differences. A prospective cohort study with a follow-up at 14 days was performed. Patients ≥16 years of age sustaining sTBI and admitted to 1 of 11 trauma centers were included. sTBI was defined by an Abbreviated Injury Scale of the head (HAIS) score >3. The centers participated from 6 months to 3 years. The results are presented as percentages, medians, and interquartile ranges (IQRs). Subgroup analyses were performed for patients ≤65 years (younger) and >65 (elderly). sTBI was observed in 921 patients (median age, 55 years; IQR, 33-71); 683 (74.2%) were male. Females were older (median age, 67 years; IQR, 42-80) than males (52; IQR, 31-67; p<0.00001). The estimated incidence was 10.58 per 100,000 inhabitants per year. Blunt trauma was observed in 879 patients (95.4%) and multiple trauma in 283 (30.7%). Median Glasgow Coma Score (GCS) on the scene was 9 (IQR 4-14; 8 in younger, 12 in elderly) and in emergency departments 5 (IQR, 3-14; 3 in younger, 8 in elderly). Trauma mechanisms included the following: 484 patients with falls (52.6%; younger, 242 patients [50.0%]; elderly, 242 [50.0%]), 291 with road traffic accidents (31.6%; younger, 237 patients [81.4%]; elderly, 54 [18.6%]), and 146 with others (15.8%). Mortality was 30.2% (24.5% in younger, 40.9% in elderly). Median GCS at 14 days was 15 (IQR, 14-15) without differences among subgroups. Estimated incidence of sTBI in Switzerland was low, age was high, and mortality considerable. The elderly had higher initial GCS and a higher death rate, but high GCS at 14 days.
authors.affiliation: 1 Division of Anesthesiology, University Hospitals of Geneva (HUG) , Geneva, Switzerland .
authors.forename: Bernhard
authors.initials: B
authors.lastname: Walder
authors.forename: Guy
authors.initials: G
authors.lastname: Haller
authors.forename: Marie My Lien
authors.initials: MM
authors.lastname: Rebetez
authors.forename: Cecile
authors.initials: C
authors.lastname: Delhumeau
authors.forename: Ezra
authors.initials: E
authors.lastname: Bottequin
authors.forename: Patrick
authors.initials: P
authors.lastname: Schoettker
authors.forename: Patrick
authors.initials: P
authors.lastname: Ravussin
authors.forename: Monika
authors.initials: M
authors.lastname: Brodmann Maeder
authors.forename: John F
authors.initials: JF
authors.lastname: Stover
authors.forename: Mathias
authors.initials: M
authors.lastname: Zürcher
authors.forename: Alois
authors.initials: A
authors.lastname: Haller
authors.forename: Adrian
authors.initials: A
authors.lastname: Wäckelin
authors.forename: Christoph
authors.initials: C
authors.lastname: Haberthür
authors.forename: Javier
authors.initials: J
authors.lastname: Fandino
authors.forename: Chiara Simone
authors.initials: CS
authors.lastname: Haller
authors.forename: Joseph
authors.initials: J
authors.lastname: Osterwalder
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000453:epidemiology* / Q000401:mortality; D003627:Data Interpretation, Statistical; D004632:Emergency Medical Services; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007182:Income; D008297:Male; D008875:Middle Aged; D018401:Sample Size; D012737:Sex Factors; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome